The Limits of ABA

Behavior therapy—ABA, behavioral science, however you may call it—is not helping Charlie's behavior problems. In fact, it may have even made them worse.

I'm not taking issue with ABA as a whole. Charlie has been in some sort of school or educational program in which ABA was the main teaching methodology since he was just over 2 years old. Jim and I did our best to learn ABA ourselves and to apply our learning to teach Charlie, whether to ride a bike or to play cello. But it now seems that the very "tight," "state of the art" (as some might say) ABA program in place in our school district has prolonged the "challenging behaviors" — head-banging, for one—that have dogged Charlie for years. Indeed, it was precisely because Charlie had so many "behavioral challenges" that we stuck with ABA over the years.

Now, though, it seems that we need very much to think outside the ABA box and see it as one teaching methodology, one teaching philosophy, one approach, among others. After over ten years of ABA and, in particular, discrete trial teaching, Charlie is quite wise to the whole business of "breaking down a task into small parts," of using a schedule of reinforcement to increase the frequency of a behavior–hold up a cracker in front of him and talk about "working" for it, and he knows the song and dance that will follow.

While we await the observations of a Ph.D.-level BCBA who our school district is supposed to behave complete a Functional Behavioral Assessment on Charlie (finally—this should have been done last spring when things got to the point that Charlie's teacher brought up Bancroft, if not even earlier), Jim and I have increasingly felt our heads knocking on the walls of that ABA box when we're told that the "functions of Charlie's behavior" are attention, escape, access to tangibles, communication, "automatic reinforcement" (i.e., sensory needs), "other." Our school district did what they call can "informal FBA" (not so sure such a thing exists outside our school district) and, despite repeated requests, just says that "classroom staff" completed this "informal FBA" and has (dodgily) not provided names of credentials of the "staff." In keeping with its "informality," that "informal FBA" (which the school district did without asking for our consent) ended up concluded that there were multiple factors controlling Charlie's behaviors. A conclusion which seems rather to state the obvious.

"State of the art" ABA having seen fit to "manage" Charlie's "behaviors" with the less than artful, and quite forceful, methods of a helmet and physical restraints, it indeed seems that ways of helping him need be sought elsewhere. Jim and I were able to reduce head-banging and all sorts of what gets called "challenging behaviors" last summer by keeping two rather vague principles in mind:

•Attentiveness to Charlie’s struggle and desire to communicate, and the ways in which what he says is not always what people assume is meant.

In particular, the notion of putting some "behaviors" on "extinction" by "ignoring" them has quite gone out the window. For instance, as noted, Charlie says a fair amount of words that seem out of context. They're considered "non-contextual" utterances and are not responded to by the staff in his classroom who instead "give him words"—phrases that have been deemed "appropriate"—to say. While this strategy does acknowledge Charlie's desire to communicate, it overlooks his own efforts to use whatever means he can do communication and imposes what someone else thinks "appropriate" on him. Of course it's important (necessary) for him to learn to communicate in ways that many people understand, but some vital mistake is being made when his own efforts to communicate are pushed aside.

Further, "breaking down" tasks into steps discrete-trial style or teaching something through "backward chaining" (in which a skill such as shoe-tying is taught by teaching the last step first) no longer seem to be so effective in teaching Charlie. He's a careful watcher of the world around him and can see that many (most) people don't have tasks "broken down" for them, and learns things in a sequence of first step first. Indeed, we've noted that Charlie is very interested in the process in which things are done: Like anyone, he's learning to bake brownies not by first learning to take the pan out of the oven, but by getting out the bowl and the ingredients.

And, in answer to the million-dollar question: Okay, so how do you handle "challenging behaviors" if not through behavioral methods?

This isn't the total answer and I'm working on putting together something more complete as I write up some things for Charlie's new teacher. But what has been working, and worked on Sunday afternoon when Charlie woke up from a two-hour nap (he'd woke at 6.15am, gone on a 9-mile bike ride with Jim on which some barking dogs rattled Charlie) and cried out "Barney video," a telltale sign of "I feel frazzled and I feel something brewing in me"—that was the last thing he said last Monday before a huge neurological storm overcame him—what has been helping has been to acknowledge and validate Charlie for feeling what he feels. (Who doesn't appreciate it when their feelings are acknowledged and understood by others?) And then (and I know this sounds New Age-y and Zen-ish; so be it), to project a sense (okay, a vibe, an aura) of peacefulness and to let go of any tenseness, worry, anxiety we may feel rising in ourselves as we worry about "what Charlie might do." I guess you could say, we try to communicate to him, mostly non-verbally, that we know how he feels and we're confident he can manage.

He did Sunday blinking and shaking and rubbing his head on the couch and whatever had been worrying him passed.

(It was a lovely Sunday, and a lovely weekend, too—in contrast to last week's—by the way.)

Comments

Have you looked at RDI? A family I provide respite for has just gone this route with their on-the-spectrum son (incidentally they started looking into other approaches when they felt he had gotten as much as he could out of ABA). I am doing lots of reading up on it and it is all about emotion and communication and attentiveness. Really interesting and useful stuff.

I’ve always been a bit skeptical about ABA. Something always seemed to be a bit “off” in the way that it operates. I tend to also be skeptical and wary of many of the methods used, since I’m not seeing a lot of ethical and reliable studies being done for them.
Of course, this could be that I’m a self-taught autistic. But I hope you find the best way to help Charlie and the best to all.

I think that there is a place for ABA, but that it is limited. We all use and have used upon us, operant conditioning, it occurs in everyday situations, most people like being praised for a job well done for example. But if the “science” of ABA prevents teachers from using intuition and from seizing on those learning opportunities that pop up during the day, for the sake of sticking to the ABA schedule, then something is going wrong.
ABA insists that you must stick to it exclusively – why? The belief that it only works if you adhere rigidly means teachers are abandoning common sense believing the ends justifies the means? Or possibly because statistics to its effectiveness can only be gained if it’s employed exclusively?
The teaching style becomes robotic, so I think we can either expect the learners to become robotic, or to fight against it.
Strangely (or maybe not) in the UK more and more professionals are pointing out the limitations of ABA, and it is rarely suggested that it should be used exclusively. Cultural difference? I have no idea.
We have always had to be very careful of how much we push Dimitri, he is more likely to retreat if a task in isisted upon or in a particular order or too frequently. He won’t keep answering the same questions (as in “why? you’ve asked me that before”). But he also likes process, so this has meant he has enjoyed using a picture schedule to go through some tasks, and the process of moving the pictures from the schedule when completed, but again, once the novelty wears of, he will reject this too.
I think sensitivity and acknowledging another persons feelings are things to be encouraged.
I like the “projecting a sense of peacefulness”, even if it does sound a bit New Age-y.

I’m really liking where your head is in this post. 🙂 Accepting and working with his concept-to-verbal-word associations, how language works for him.
Sure continue to work on teaching him associations that are more typical, a laudable longterm goal to expand his world. But you still have to get through today, he still needs to know he’s being heard.
>> I guess you could say, we try to communicate to him, mostly non-verbally, that we know how he feels and we’re confident he can manage.
And of course he picks up that communication. If I correctly recall, the first post of yours I read gave a sense that Charlie was sensitive to body language/voice tone.

I’ve never been a fan of ABA, truth be told.
Looking back, I come to the conclusion that it is stressful on the child… Sometimes too stressful for what is being told.
Don’t get me wrong, it definitely has some positives and some kids do wonderfully on it, I just don’t feel it’s as good and as perfect and necessary as what it is often made out to be.
I think the best thing to do is try different approaches and take the concepts from each that work and combine them.
That’s worked for me at least!
Good luck with Charlie!

The ABA we had with the little one was a program of skills that they refused to modify for the child and refused to move on until a particular skill was perfect.. How many times can you match, sort, draw a straight line.. then get a toy for 2 seconds before you’re pissed off… That is simply Pavlov’s Dog training. The only behavioural issue we’ve ever had with the little one was the day he assaulted his Male T May 2006… gives his opinion on the subject doesn’t it. Also, to this day he’s VERY suspicious of new teachers/therapists in his sphere. No behaviours, just wary.
ABA is simply learning the word “No” and both of mine learned that early. It can be reinforced by everything from time-out’s to removing of electronics.
My eldest has a token style program http://www.edu.gov.on.ca/extra/eng/ppm/140.html under Ont’s PPM 140. This has allowed them to help him learn appropriate classroom behaviour and playground survival skills. They use it along with small group activities and short stories. Very basic, very concise rules to follow/skills to learn. And it has worked very well.
We don’t attempt to remove behaviours except for handwringing and deep pressure on the floor… I simply say “No hands” or “sit please”… both are lessening… both may go or not over time… With a lot of hard work, and because he now speaks “normally” we were able to get rid of the eldest’s headbanging in exchange for using our words instead. We have learned to translate phrases – such as you have – and work to replace those phrases with appropriate words. We don’t push, we just repeat them using correct words, wait and see if we’ve guessed right, they usually repeat it properly… and we move on. We don’t make a production out of it. It’s taken a lot of time, especially with the little one… but IMO.. it’s paid off 100%.
We use alternate technology like calculators and computers for writing and math.
We keep looking outside the box. The school has learned this as well.. not immediately… but they are learning.

The ABA we had with the little one was a program of skills that they refused to modify for the child and refused to move on until a particular skill was perfect.. How many times can you match, sort, draw a straight line.. then get a toy for 2 seconds before you’re pissed off… That is simply Pavlov’s Dog training. The only behavioural issue we’ve ever had with the little one was the day he assaulted his Male T May 2006… gives his opinion on the subject doesn’t it. Also, to this day he’s VERY suspicious of new teachers/therapists in his sphere. No behaviours, just wary.
ABA is simply learning the word “No” and both of mine learned that early. It can be reinforced by everything from time-out’s to removing of electronics.
My eldest has a token style program http://www.edu.gov.on.ca/extra/eng/ppm/140.html under Ont’s PPM 140. This has allowed them to help him learn appropriate classroom behaviour and playground survival skills. They use it along with small group activities and short stories. Very basic, very concise rules to follow/skills to learn. And it has worked very well.
We don’t attempt to remove behaviours except for handwringing and deep pressure on the floor… I simply say “No hands” or “sit please”… both are lessening… both may go or not over time… With a lot of hard work, and because he now speaks “normally” we were able to get rid of the eldest’s headbanging in exchange for using our words instead. We have learned to translate phrases – such as you have – and work to replace those phrases with appropriate words. We don’t push, we just repeat them using correct words, wait and see if we’ve guessed right, they usually repeat it properly… and we move on. We don’t make a production out of it. It’s taken a lot of time, especially with the little one… but IMO.. it’s paid off 100%.
We use alternate technology like calculators and computers for writing and math.
We keep looking outside the box. The school has learned this as well.. not immediately… but they are learning.

I worked at an ABA school for a bit—I think most the teachers there looked upon it as personal failure to “need” to use the methods. They were very keyed into the kids moods. Like the PaPa Bear teacher in Ben’s Aspergers class…who felt kids must feel loved and protected FIRST…Hey, but we are all human and make mistakes. But when a militaristic (literally) paychologist came into the classroom, Ben left.
I know it isn’t easy. May your path unfold before you! (How’s that for mysticism?)

We never used full on ABA here. I read the book, figured out what techniques would work (and what wouldn’t) and used those for whatever I needed them while he was young.
ABA is not the answer to everything. While I do agree that it works best with young kids, once they are older and have minds of their own, they don’t appreciate being treated like trained monkeys. I wouldn’t, either. So don’t feel bad about not using it any more. He needs something else now, and it’s time to go find it. 😉

We use positive behaviour support strategies with our child, which focus on the belief that all behaviour is communication – which seems to be where you are heading instinctively. I have a personal sense of discomfort with ABA, both for the methodology and for its history, and I believe that its effectiveness is overstated by practitioners. It’s not the only way for our kids – as you say, it is one of many strategies that can be effective.

This was heart-wrenching for me to read. Please accept an apology from one dyed-in-the-wool behavior analyst for the ineptitude that you’ve endured. Behavior science has grown immensely since the days when discrete trial teaching was the only game in town for teaching children with autism. There are now many alternatives that can be used as your child grows and learns; natural environment teaching, pivotal response training, and video modeling are just a few modes of instruction that are worth exploring. Some children need to learn via backward chaining, but if Charlie has progressed as you suggest, the forward chaining or total task presentation would be more suitable for where he is at now.
Your sensitivity to Charlie’s communication style, your understanding of his precursor behaviors and what he is saying to you when he uses words idiosyncratically should be listened to with care by any behavior analyst who is working with your son. These are priceless bits of information that aid in the development of sound educational goals. Charlie should be learning ways to gain access to those things that are important to him in ways that are socially appropriate. This would make him powerful in the context of his world, something we all want. If this were a focus of his training, you would immediately see a reduction of problem behaviors and an increase in effective learning at school.
There are tools such as the Assessment of Basic Learning Abilities that are very useful for determining the level of instruction and the type of prompting that would be most effective. I’m guessing that no one has offered to utilize these tools with Charlie, and I’m saddened by this.
No need to apologize for sounding Zen. In fact, a clinical psychologist and behavior analyst we work with at UNR named Steve Hayes has strongly advocated for the use of psychotherapy with children and adults who have disabilities. Steve is the founder of Acceptance and Commitment Therapy, ACT, and has offered training to some of us in the use of ACT techniques modified for kids with autism. There has been some preliminary research and the data are very encouraging. ACT is in fact very gestalt, and places emphasis on relating to an individual’s feelings before helping him to de-fuse from them in order to be more effective.
Once again, please accept an apology from someone who has also seen unprofessional efforts from poorly trained behavior analysts. There are others among us who will listen to you, work with you, and generate novel approaches that are designed specifically for Charlie. I hope that you’ll seek out a well trained board certified behavior analyst before you give up entirely on behaviorism.
Tom Szabo, M.A.

This was heart-wrenching for me to read. Please accept an apology from one dyed-in-the-wool behavior analyst for the ineptitude that you’ve endured. Behavior science has grown immensely since the days when discrete trial teaching was the only game in town for teaching children with autism. There are now many alternatives that can be used as your child grows and learns; natural environment teaching, pivotal response training, and video modeling are just a few modes of instruction that are worth exploring. Some children need to learn via backward chaining, but if Charlie has progressed as you suggest, the forward chaining or total task presentation would be more suitable for where he is at now.
Your sensitivity to Charlie’s communication style, your understanding of his precursor behaviors and what he is saying to you when he uses words idiosyncratically should be listened to with care by any behavior analyst who is working with your son. These are priceless bits of information that aid in the development of sound educational goals. Charlie should be learning ways to gain access to those things that are important to him in ways that are socially appropriate. This would make him powerful in the context of his world, something we all want. If this were a focus of his training, you would immediately see a reduction of problem behaviors and an increase in effective learning at school.
There are tools such as the Assessment of Basic Learning Abilities that are very useful for determining the level of instruction and the type of prompting that would be most effective. I’m guessing that no one has offered to utilize these tools with Charlie, and I’m saddened by this.
No need to apologize for sounding Zen. In fact, a clinical psychologist and behavior analyst we work with at UNR named Steve Hayes has strongly advocated for the use of psychotherapy with children and adults who have disabilities. Steve is the founder of Acceptance and Commitment Therapy, ACT, and has offered training to some of us in the use of ACT techniques modified for kids with autism. There has been some preliminary research and the data are very encouraging. ACT is in fact very gestalt, and places emphasis on relating to an individual’s feelings before helping him to de-fuse from them in order to be more effective.
Once again, please accept an apology from someone who has also seen unprofessional efforts from poorly trained behavior analysts. There are others among us who will listen to you, work with you, and generate novel approaches that are designed specifically for Charlie. I hope that you’ll seek out a well trained board certified behavior analyst before you give up entirely on behaviorism.
Tom Szabo, M.A.

You are absolutely right in what you are saying about language.
It sounds like a Mediated Learning Experience approach might be the sort of thing that would be helpful, but I don’t see any centers in New Jersey. Do you know this approach? (http://en.wikipedia.org/wiki/Reuven_Feuerstein)

@beautyobscure, we’ve definitely looked into RDI–I read some books on it a few years ago and we had some hesitancies due to above-stated behavior issues. But I think some of the concepts/techniques stayed in my mind, unconsciously….
Just want to thank everyone for your comments, which I’m processing and will respond to……. we haven’t 100% given up on ABA, but certainly on this particular program. Charlie’s new school definitely uses ABA but not as intensely and our hope is to have our former Lovaas consultant back observing Charlie regularly; her main dicta were “fun” and “flexible.” But Charlie does seem to need more breathing room, so to speak.

Study re: Parental Perceptions as to the Efficacy of Applied Behavior Analysis (ABA)
Are you are NJ Parent of a child with autism aged birth to 21 who is currently receiving or has received ABA interventions? If so, we are seeking research participants. Click here or copy link to participate online: https://www.surveymonkey.co/s.aspx?sm=_2bNMDc3EHUp8fM38T3KN_2f7w_3d_3d

As a BCBA, I’m sorry to hear about your experience. ABA is to be data driven, and a behavior that continues for a long time means someone is not examining the data and making changes, or not listening to what the child expert (the parent) has to say.
Just as there are quacks with medical doctors, you will find the same across all professional areas. Not all BCBA’s are the same, or trained the same.
Good luck to you in the future,
Dana Garner, BCBA

As a BCBA, I’m sorry to hear about your experience. ABA is to be data driven, and a behavior that continues for a long time means someone is not examining the data and making changes, or not listening to what the child expert (the parent) has to say.
Just as there are quacks with medical doctors, you will find the same across all professional areas. Not all BCBA’s are the same, or trained the same.
Good luck to you in the future,
Dana Garner, BCBA

In my opinion, ABA and public school do not mix well. Public schools have different agendas. Their prime focus are budgets and politics. Have they really done ABA the way that they should have? I think, for example, the helmet was not about ABA, but about legal liability. And the absence of the consultant = budget?

Hi, I have a son who is different to yours (dx Aspergers, very verbal) but has mood swings and very erratic behaviour (like yours!).
All I can say is hooray for you! I think ABA is junk science, it is CLEARLY not working for Charlie and has equally clearly undermined your confidence in yourself as parents. You, unblinded by rote learning and devotion to any bogus method, can see and hear the real Charlie and just look at how he responds to basic care, listening, understanding – just as we all do. How DARE his school truss him up in a helmet and restrain him! I could cry to read about it. It must tear you to pieces, and heaven only knows what it does to Charlie. If I were you I’d just stop all that right now. Take him out of school if necessary. I’m in the UK which I don’t think does this sort of stuff to autistic kids (for which I am hugely grateful) but even I have battled very fiercely for my son to be listened to (I’m ‘scary’ apparently! 🙂 ), and understood and treated as a human being with disabilities that make him no less valuable than any other human being. I told one teacher who was banging on about making my son the ‘same as everyone else’ that he was NOT the same as everyone else. That difference is not shameful and that if he was in a wheelchair they wouldn’t be insisting he climbed the stairs to be ‘the same as everyone else’. they’d put in ramps and lifts and make the environment fit the child. My son has always (on my insistence) had escape routes from school stress, he could go to a quiet corner with books or could walk around the empty playground for a little while if he felt overloaded. We used to get called every single day to say he was trying to run out of school or was turning over furniture before lunch, and was on the verge of being excluded. I told them he was just plain HUNGRY and like a lot of kids with sensory differences, found this feeling intolerable. And in the end I raised hell and I absolutely insisted he had a snack at 11am even if it wasn’t ‘school policy’! And guess what? These episodes just stopped. As for Charlie’s ABA practitioners, I am just STAGGERED to see that you need someone with a PHD to state utter bilge like, “the functions of Charlie’s behavior” are attention, escape, access to tangibles, communication, “automatic reinforcement” (i.e., sensory needs), “other.”
That’s true for EVERYONE! We all do everything we do for those reasons, what else is there? Why do we need to pathologise everything autistic people do? If Charlie got those things, as he does with you, his lovely parents, then he wouldn’t be as frustrated and unhappy. I have learned a lot about the origins of ABA, such as trying to force ‘feminine’ (aka gay) boys to be more ‘masculine’ and punishing them if they didn’t conform. Nowadays we think that barbaric and openly gay and ‘feminine’ men can become loved and successful. Changing our idea of ‘normal’ worked a hell of a lot better there for these people and for the rest of us than trying to change the inherent characteristics of these small human beings.
On another note, I find it utterly bizarre that any progress whatsover by a child subjected to ABA is attributed to ABA. Autistic kids are human first and foremost, and like all kids they change and develop as they get older. At eight my son has started to want to join in and do stuff other kids do (eg join his school’s after-school Spanish class) and seems for the first time to be able to cope with it. He has learned to ride a scooter because he wanted to. I long ago gave up any therapies with my son – he hated them all – and let his interests and desires guide us, and it has taken us to interesting places. I know a hell of a lot more about atoms, say, than I would have done without him! So he can’t and won’t draw a picture for his homework? So what?
I’m sorry this is such a long post but I sense you absolutely know that this wretched ABA isn’t working, that you know best, and I just want to say, yes, you do. You are his best advocate, because you are the only people listening to the child, not a textbook. Stand your ground!

@Thomas Szabo,
First, thank you for your heartfelt comment—as I wrote in another post today, we certainly haven’t completely given up on ABA and are looking forward to working once again with Charlie’s former Lovaas consultant.
Considering that the ABA consultant to our school district is starting a PhD in ABA at her college, I’m quite sure that she knows about the ABLLS, pivotal training, etc.. The question is whether any of those were ever used in our school district and, if they were, as their use documented? While she was constantly cited in decisions made about Charlie, the consultant does not seem to have written any reports or otherwise left a paper trail of her suggestions and observations.
I especially appreciate your mention of ACT, thank you, I am looking it up!
Thank you again —

@farmwifetwo, good to hear the school is listening (to your kids and you…..)
@Dana Garner BCBA, thank you! a lot of data is taken in Charlie’s class, graphed regularly, etc.. I guess I have been wondering at how all the data is interpreted and understood—

@farmwifetwo, good to hear the school is listening (to your kids and you…..)
@Dana Garner BCBA, thank you! a lot of data is taken in Charlie’s class, graphed regularly, etc.. I guess I have been wondering at how all the data is interpreted and understood—

I’m late to the party but still wanted to comment! I work at a private ABA school for children with autism and am running into some frustrations with it myself.
My biggest issue with ABA is that typically there is a certainty within this community that this is The Answer and must never be strayed from. Some children have the exact same behaviors after years of ‘extinction’ ‘positive reinforcement’, etc., and yet there’s never any doubt that this is the ‘right’ way to address these problems.
Occasionally children have much bigger issues – i.e., a child who seems to ruminate obsessively about plans to harm others and enjoys hurting animals… and he gets the same ‘tsk tsk, we’re taking down a token, that’s five minutes of computer time lost!’ when he attacks a teacher and gives her a black eye. The idea being tokens/rewards/immediate small consequences have to work for everyone, be they autistic or severely emotionally disturbed.
Other beefs…I notice a lot of what the kids learn in terms of language is not really used in a functional sense. I have kids who can answer dozens of wh- questions on request but are more or less nonverbal when it comes to spontaneous speech.
I think ABA is a tool, but one tool in the ‘ol toolbox!